Surgical Treatment of Cutaneous Tumors and Reconstruction of the Resulting Defects: The Contemporary Role of the Rhombic (Limberg) Flap
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Abstract
Cutaneous tumors are the most frequent malignancies in fair-skinned populations, and the majority arise on the head and neck, where complete oncological excision must be reconciled with strict aesthetic and functional demands. This narrative review examines the contemporary treatment of skin tumors from both perspectives. The oncological section summarizes risk stratification, margin selection for basal cell carcinoma, cutaneous squamous cell carcinoma and melanoma, the role of micrographic and frozen-section margin control, and the principle that definitive flap reconstruction must never precede documented clearance. The reconstructive section analyses the rhombic (Limberg) transposition flap as the principal model of local reconstruction, covering terminology, historical development, the vascular anatomy of the dermal-subdermal plexus on which random-pattern flaps depend, the geometry of the classical 60/120-degree design, and the Dufourmentel, Webster, Quaba-Sommerlad, multiple-flap and hybrid modifications. Published clinical series are reviewed, together with complications, contraindications and non-surgical alternatives. Contemporary evidence, although limited to small retrospective series, consistently reports flap survival approaching 100%, same-day discharge under local anesthesia and high patient-reported satisfaction, particularly in elderly patients with favorable skin laxity. The rhombic flap remains a first-line option for small and medium-sized defects of the lateral midface and cheek, provided that the flap vector is selected according to the lines of maximum extensibility and that the technique is adapted to the defect rather than the defect to the technique
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